On a more insidious note, Puerto Rico's status as a territory results in a much reduced level of support for Medicaid.
- Emigration from the island is leaving an increasingly elderly and poor population, which increases the percentage of the remaining citizens covered by Medicaid. Roughly half of the island's residents rely on Medicaid.
- The matching rate for Puerto Rico stands at 55%. For states with similar income levels (eg Mississippi), the matching rate is 76%. (Note that Puerto Rico's poverty rate in 2015 was 46%. By comparison, Mississippi, the poorest state, had a poverty rate of 22%.)
- Federal funds for matching in territories (unlike states) are capped. Since Puerto Rico is large and has a large Medicaid population, only $329M was matched in 2015, which amounted to an effective 14% matching rate.
- A bump in funding for Puerto Rico's Medicaid funding was included in the Affordable Care Act. The provision providing that funding runs out of money this year (2017). The result is that half of Puerto Rico's current Medicaid population may find themselves uninsured.
Health issues related to Hurricanes Irma and Maria are likely to increase rather than decrease health cost obligations. The PROMESA Fiscal Oversight Management Board (FOMB) is demanding a 6% reduction in health care spending. There is no way to get to that spending level aside from spending cuts that will come at a horrific human cost.
Puerto Rico would benefit from calls by Senator Sanders and others to expand Medicare eligibility to all Americans, as long as those reforms also apply to citizens living in US territories. But changes are needed now.
Calls To ActionPlease contact your Senators and Representatives to demand that:
- Puerto Rico's health care reimbursements be brought into line with the rest of the country.
- The PROMESA Fiscal Oversight Management Board (FOMB) be instructed to look for a fairer reimbursement system to close the budget gap rather than looking to program cuts.
- Any health care reform to expand Medicare coverage MUST include Puerto Rico.